The relationship between hospital and territory in the implementation of continuity care: The case of the end of life

Manuela Tomai, Veronica Rosa, Valentina Bua, Rossella Valotta

Abstract

Continuity of care is a fundamental principle in primary care. It responds to the integration and collaboration principle between different health-care services. At the organizational level, continuity of care is the provision of services included in a management plan that uses a shared model of network work.
Implementing the network between hospital and territory implies a radical cultural change, which shows many difficulties to be achieved in Italian reality. The complexity of this challenge is most evident in the management of end of life, especially for physicians. In this regard, in our study we posed the following research questions: As physicians represent the continuity between hospital and territory in the management of terminal patients? What are the cultural characteristics of the Hospital and Hospice? How it is treated the issue of the end of life? Therefore, main objective of the research was to investigate the cultural models that organize the representations of physicians regarding continuity of care in the end of life. Through semi-structured interview, were interviewed 10 physicians (4 UOC of Medical Oncology Hospital, 4 of the Division of Emergency Medicine Hospital and 2 of hospice), operating in Umbria territory. The texts of the interviews were fully transcribed and analyzed through the Interpretative Phenomenological Analysis (IPA). Overall, the findings highlight a offer of services to the terminal patient not included in a shared network and a culture of continuity of care still weak but strongly different in the two contexts. The handover process appears to be a formal practice, not built on the patient and family’s needs, and acted when the end of life is imminent. The function of the psychological profession is discussed, highlighting the need for its placement within the care team, not only with tasks of assistance to users but even on the facilitation of the working group processes and handover construction.